The Bush- Francis Catatonia Rating Scale (BFCRS) is a standardised, quantifiable examination of catatonia designed to screen and diagnose. Tab. 1: According to the item Bush-Francis Catatonia Rating Scale (BFCRS), here partially modified and partially reported, the severity of catatonia is. PDF | Objective: This article aims to describe the adaptation and translation process of the Bush-Francis Catatonia Rating Scale (BFCRS) and.

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Psychomotor symptomatology in psychiatric illnesses. In this exploratory open label study, we investigated the prevalence of catatonia in an acute psychiatric inpatient population. In addition, differences in symptom presentation of catatonia depending on the underlying psychiatric illness were investigated.

A factor analysis was conducted in order to generate six catatonic symptom clusters. Composite scores based on this principal component analysis were calculated. Interestingly, when focusing on the DSM-5 criteria of catatonia, 22 patients Furthermore, different symptom profiles were found, depending on the underlying psychopathology. There was a high prevalence of catatonic symptomatology. Depending on the criteria being used, we noticed an important difference in exact prevalence, which makes it clear that we need clear-cut criteria.

Another important finding is the fact that the catatonic presentation may vary depending on the underlying pathology, although an unambiguous delineation between these catatonic presentations cannot be made. Future research is needed to determine diagnostical criteria of catatonia, which are clinically relevant.

Catatonia is a psychomotor symptom cluster characterized by a heterogeneous group of mental, motor, vegetative, and behavioral signs.

The Detection and Measurement of Catatonia

The recognition of catatonia is essential since it is a syndrome that can be effectively and rapidly relieved in most cases. Whereas, the pathophysiology of catatonia is still unknown, it is clear that the psychomotor syndrome results from many etiologies 1. Although some critics have suggested the syndrome is much more uncommon than a century ago or may even be disappearing, catatonia is still highly prevalent 2. Most recently, the DSM-5 rightfully loosened the association between schizophrenia and vatatonia that was predominant in its preceding editions and now recognizes that catatonia can be induced by different disorders In the study of Pommepuy and Januel, including catatonic patients, there was an average of The review of Caroff and colleagues shows similar results There are reasons to believe that the profile of catatonic symptomatology may depend on the underlying pathology 15 This notion is very intriguing since it can both have diagnostical and therapeutical implications and give clues toward future research on the underlying pathophysiology of the psychomotor syndrome.

In the present study, prevalence of catatonia in an acute psychiatric inpatient population was investigated. In an exploratory open label study design, each patient admitted to a psychiatric intensive ward during a period of 12 months rrancis assessed for catatonic and clinical symptomatology. The patients busb to this department were experiencing the most acute phase of a mental illness.

The department is for men and women over the age of 18 year who require a period of psychiatric intensive care. The assessments were conducted on the first day of admission in the hospital. There were no exclusion criteria for participation.

All of the patients who were admitted to the psychiatric intensive ward were included in the study. A total group of patients female: The mean age was Major depressive disorder was the main diagnosis in six patients 4. Similarly, six patients received a diagnosis of personality disorder 4.


The Detection and Measurement of Catatonia

Antipsychotics were taken by Antidepressants were administered to It measures the severity of 23 catatonic signs. The PANSS is a widely used medical scale for measuring symptom severity of patients with schizophrenia. Scores ranging from 1 to 7 are given on 30 different symptoms in three subscales positive scale 7 items, negative scale 7 items, general psychopathology scale 16 itemswith total score ranging from 30 to The YMRS is a rating scale to assess manic symptoms.

Additional information is based upon clinical observations made during the course of the clinical interview. The SAS is used to measure extrapyramidal symptoms. It is composed of 10 items and signs.

Catatonic symptomatology was highly prevalent in our patient sample. When focusing on the first 14 items of the BFCRS, which are suggested for using the instrument as a screening tool, patients Interestingly, when focusing on the DSM-5 criteria of catatonia at least 3 out of 12 selected symptoms22 patients Prevalence of catatonia in an acute psychiatric patient sample according to different criteria.

A factor analysis Principal Component Analysis, varimax rotation was conducted in order to generate catatonic symptom clusters.

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Given that items grasp reflex and waxy flexibility had a zero variance, these items were excluded from the analysis. This yielded six symptom clusters see Table 3: Out of the total patient group, 88 Similarly, all patients completed a YMRS: The total patient sample was divided in four groups: Patients with a psychotic or mood disorder as a primary diagnosis had the most prominent catatonic symptom profiles see Figure 1.

No differences between the psychosis group and the combined mood disorder group could be seen. Very similar results were found after controlling for extrapyramidal symptomatology by use of the total score on the SAS. These results could mostly be explained by the fact that the SUD- and patient-OD groups hardly showed any catatonic symptomatology. Kontaxakis and colleagues found this subscale to intercorrelate with the Hamilton Depression subscale Out of the patients that were admitted to an enclosed psychiatric ward, patients In other words, catatonic symptomatology was highly prevalent in our patient population, although in most cases mildly.

Our current findings demonstrate the presence of at least one symptom that is labeled as being catatonic by the BFCRS in most of the patients admitted to an enclosed psychiatric ward.

In these studies, different criteria to diagnose catatonia were used, which renders a comparison between different studies on the prevalence of catatonia more difficult. For example, in the study of Lee, DSM-criteria were used to classify catatonia When we used the latest DSM-criteria, only Fink and Taylor made their own diagnostic criteria with emphasis on the duration of the catatonic symptoms Consequently, these divergent findings raise two interesting points. Depending on which criteria are being used, the more strict DSM-criteria versus the more liberal criteria suggested by Bush and colleagues i.

Of note, the DSM-5 criteria for catatonia appear to be even more strict than those of its predecessor, even if all 12 items, which were clustered in five categories in the DSM-IV can now be scored separately. This is mainly due to the fact that now three instead of two items have to be present. On the other hand, the high prevalence of symptoms using the BFCRS-criteria was mostly explained by the presence of mild symptomatology, whereas, more severe symptoms were present in a minority of our sample.

Consequently, our results seem to point out that catatonic features, and more broadly psychomotor symptoms, may deserve a dimensional approach, much like cognitive symptoms associated with these psychiatric illnesses It should also be noted that the most prevalent catatonic symptoms were not the strictly motor symptoms, which mostly seem associated with the traditional view on catatonia. Cognitive symptoms like perseveration and affective symptoms like excitement were the most prevalent and their validity and specificity as catatonic features should be questioned, especially in the more mild presentations.


The unknown pathophysiology may contribute to the different views on catatonia. An unifying pathogenesis of catatonia that explains all motor, vegetative, and behavioral symptoms remains elusive. As a result, an unclear clinical concept of catatonia exists with the use of different diagnostical criteria and different rating scales to score catatonic symptomatology. In our study, no significant differences in overall prevalence of catatonia between the psychosis group and the combined mood disorder group could be seen.

Other studies also show that the syndrome is highly prevalent in both psychotic and mood disorders However, again, different criteria for catatonia were used in these studies.

Different catatonia symptom profiles were found, depending on the underlying psychopathology. Kraepelin already suggested that catatonia had a different symptomatology depending on the underlying pathology.

Partly in line with our results, he described that negativism and mannerism were mainly associated to dementia praecox 4. Similarly, Schneider compared patients with catatonic schizophrenic and manic excitement, respectively and found that schizophrenic agitated patients displayed more blocking, waxy flexibility, stereotyped speech, mutism, and negativism In a study of catatonic adolescents, automatic obedience and stereotypies were significantly more associated with schizophrenic than they were buhs non-schizophrenic catatonia In contrast, manic patients mainly displayed catatonic excitement, whereas, depressed patients were characterized by catatonic inhibition in terms of stupor, mutism, and rigidity This was also in line with our findings, since symptoms of excitement and combativeness was significantly more present in the manic patients sample and significantly less in the depressed group, when compared to the psychotic patients sample.

Some limitations of our study should be pointed out. First, the impact of medication could be a confounding factor in our study. catatoonia

A vast number of patients were taking benzodiazepines at the time of testing, which could have masked more severe presentations catatinia the catatonic syndrome.

Another limitation of the study is the lack of a depression scale. To overcome this limitation, we used the PANSS-dep but a dedicated depression scale would have been more elegant. Moreover, the sample size was rather small, especially in some subgroups. Larger scale trials are needed to replicate our findings. In conclusion, there was a high prevalence of catatonic symptomatology. Remarkably, there is an important difference in exact prevalence depending on the criteria being used, which makes it clear that we need clear-cut criteria.

All authors had access to the study data and made the final decision about where to present these data.

The authors declare that fraancis research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors thank the study participants, without whom the study would never have been accomplished.

J ECT Where have all the catatonics gone? Psychol Med Dementia Praecox or Group of Schizophrenias [].

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